Maryland Fire and Rescue Institute -- Maryland Fire and ...



Assessing & Managing Stroke Patients

Time: 1 hour

References: Brady Emergency Care, 13thed (pp. 549-552) & Maryland Protocols (pp. 14-15, 152-155)

Student Objective: Given information & resources, BLS providers will be able to identify signs of a stroke, emergency care, and stroke centers.

Overview:

• Signs of a stroke

• Emergency Care

• Stroke Centers

Signs of a stroke(pp. 548-551)

• One sided weakness

• Headache

• Difficulty speaking or complete inability to speak

• Confusion

• Dizziness

• Impaired vision

• Hypertension

• Nausea or vomiting

• Loss of bowel/bladder control

• Seizure

• Unequal pupils

• Loss if vision in one eye

• Unconsciousness (uncommon)

• Difficulty breathing or snoring respirations

Assessment (pp. 549-551)

Cincinnati Prehospital Stroke Scale(MMP pp. 153)

Note: if a patient demonstrates any of the following, there is a 70% chance that the patient is having an acute stroke

1) Assess facial droop – abnormal facial droop on one side

2) Assess speech difficulties –often has slurred speech, use wrong words, or unable to speak at all

3) Arm drift – often has arm drift or palm rotation

Emergency Care Procedures

• Brady Emergency Care, 13thed (pp. 552)

o Establish & maintain a patent airway

o Provide supplemental oxygen if O2 saturation is under 94%

o Perform blood glucose analysis

o Attempt to determine the exact onset of the stroke

o Transport to a facility that can manage a patient with symptoms of a stroke

• Maryland Medical Protocols, July 1, 2017 (pp.152-155)

o Support the ABC’s

o Perform the Cincinnati Prehospital Stroke Scale

o If Cincinnati Stroke Scale is positive, perform the Los Angles Motor Scale (LAMS) (pp. 153)

o Position patients head at 30 degrees

o Complete the Fibrinolytic Checklist for Ischemic Stroke (pp. 155)

o If the patient is a candidate for fibrinolytic therapy AND can be delivered to the hospital within 3.5 hours of the last known well time, transport the patient to a stroke center. If there is no stroke center within 30 minutes, then go to the closest hospital

o If the patient meets the criteria, the patient is a Priority 1 and requires notification of the nearest designated stroke center. Use the verbiage “Stroke Alert”.

o Place pediatric patients on oxygen 2-6lpm nasal cannula unless hypoxic or in respiratory distress

o Primary Stroke Centers (pp. 14-15)

▪ Anne Arundel Medical Center, Annapolis

▪ Atlantic General Hospital, Berlin

▪ Baltimore Washington Medical Center (UM), Glen Burnie

▪ Calvert Memorial Hospital, Prince Frederick

▪ Carroll Hospital Center, Westminster

▪ Charles Regional Medical Center (UM), La Plata

▪ Franklin Square Medical Center (MedStar), Baltimore

▪ Frederick Memorial Hospital, Frederick

▪ Good Samaritan Hospital (MedStar), Baltimore

▪ Greater Baltimore Medical Center, Baltimore

▪ Harbor Hospital (MedStar), Baltimore

▪ Harford Memorial Hospital (UMUCH), Havre De Grace

▪ Holy Cross Hospital, Silver Spring

▪ Howard County General Hospital (JHA), Columbia

▪ Johns Hopkins Bayview Medical Center, Baltimore

▪ Mercy Medical Center, Baltimore

▪ Meritus Medical Center, Hagerstown

▪ Midtown Campus (UM), Baltimore

▪ Montgomery Medical Center (MedStar), Olney

▪ Northwest Hospital, Baltimore

▪ Peninsula Regional Medical Center, Salisbury

▪ Saint Agnes Hospital, Baltimore

▪ Saint Joseph Medical Center (UM), Baltimore

▪ Saint Mary’s Hospital (MedStar), Leonardtown

▪ Shady Grove Adventist Hospital, Rockville

▪ Shore Medical Center at Easton (UMSRH)

▪ Sinai Hospital of Baltimore

▪ Southern Maryland Hospital (MedStar), Clinton

▪ Suburban Hospital (JHM), Bethesda

▪ Union Hospital of Cecil County, Elkton

▪ Union Memorial Hospital (MedStar), Baltimore

▪ Upper Chesapeake Medical Center (UMUCH), Bel Air

▪ Washington Adventist Hospital, Takoma Park

▪ Western Maryland Regional Medical Center, Cumberland

o Comprehensive Stroke Centers (pp. 15)

▪ The Johns Hopkins Hospital, Baltimore

▪ University of Maryland Medical Center, Baltimore

Review:

• Signs of a stroke

• Emergency Care

• Stroke Centers

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